Diagnosis
Bezoar
A tightly packed collection of partially digested or undigested material that is unable to exit the stomach.
Etiology
Cause - repeated swallowing of an indigestible foreign body [c5q]
Phytobezoars: Nondigested plant fibers (cellulose, lignins), tannins
Lactobezoars: Undigested milk concretions
Trichobezoars: hair
Lithobezoars: stone-like materials
Pharmacobezoars: medications (Aluminum hydroxide, Bulk laxatives, Cholestyramine, Enteric-coated aspirin, Extended-release medications)
Diospyrobezoar: Persimmon skin tannin (phlobatannin)
Video capsule endoscopy in patients with inflammatory bowel disease (IBD)
Pathophysiology
Gastrointestinal obstruction
Risk factors [tsg][mnq]
Inflammatory bowel disease (IBD) due to strictures
Ileal pouch [mnq]
Mental retardation
Trichotillomania [tsg]
Drugs: Anticholinergic, opiates
Dehydration
Complications [tsg]
Ulcer/bleeding --> anemia
Gastric outlet obstruction
Ileus
Epidemiology
Incidence per 100.000 [6ek][mnq][oqg][tsg]
Symptoms & findings
Symptoms
Dehydration, Dry mucous membranes, Dysphagia, Flat neck veins, Hematemesis, Nausea, Poor skin turgor, Postprandial fullness, Regurgitation, Stridor, Vomiting, Weight loss
Clinical findings
Alkalosis, Anemia, Metabolic alkalosis
Anamneses
None listed.
Localized findings
Approach
Abdominal x-ray
Barium studies
Ultrasound abdomen
CT abdomen
Gastroscopy
Treatment
Enzymatic Disintegration (low pH soda)
Endoscopic removal
Open surgery
Psychological evaluation
Differential diagnoses
Acalculous cholecystitis, Achalasia, Acute pancreatitis, Alcoholic liver disease, Aortic dissection, Autoimmune hepatitis, Cholangitis, Cholecystitis, Cholelithiasis, Esophageal cancer, Gallstone Ileus, Gastric outlet obstruction, Gastritis, Gastroesophageal reflux disease, Gastrointestinal obstruction, Liver abscess, Myocardial infarction, Myocarditis, Pericarditis, Pneumonia, Pulmonary embolism, Splenic injury, Ulcer disease, Viral hepatitis, Zollinger-Ellison syndrome
References
[1] Xian-rui Wu, Bo Shen. Chapter 27 - Endoscopic Treatment of Bezoars and Foreign Bodies in Patients With Inflammatory Bowel Disease. Interventional Inflammatory Bowel Disease: Endoscopic Management and Treatment of Complications, Pages 309-317, 2018.
[2] Akbulut S, Değer KC, Duman M, Yol S. Gastric bezoars. Prz Gastroenterol. 2016;11(1):60-1.
[3] Sameer Berry, Bo Shen. Chapter 35 - Endoscopic Management of Pouch Bezoars, Bleeding, Inflammatory Polyps, and Other Miscellaneous Pouch Conditions. Pouchitis and Ileal Pouch Disorders - A Multidisciplinary Approach for Diagnosis and Management, 2019, Pages 429-445
[4] Liu et al. Clinical Features, Risk Factors, and Endoscopic Treatment of Bezoars: A Retrospective Analysis from a Single Center in Northern China. Med Sci Monit. 2020 Oct 7;26:e926539.
[5] https://www.uptodate.com/contents/gastric-bezoars
[6] http://emedicine.medscape.com/article/933015 (2014-01-02); [Medscape]
[7] http://www.merckmanuals.com/professional/gastrointestinal_disorders/bezoars_and_foreign_bodies/bezoars.html; [Merckmanuals]